A screening tool for identifying mental disorders in asylum-seekers & new refugees: the STAR-MH

Despite the high prevalence of mental disorders in asylum-seekers and refugees (ASR), there is no extant sensitive and brief screening tool designed to be administered by non-health trained workers. We report the results of a... [ view full abstract ]

Despite the high prevalence of mental disorders in asylum-seekers and refugees (ASR), there is no extant sensitive and brief screening tool designed to be administered by non-health trained workers. We report the results of a pilot study for such a tool – the STAR-MH.

The STAR-MH was developed through an iterative piloting process. Adult ASR without a known current psychiatric diagnosis were recruited through two agencies which provide for the health and psychosocial needs of ASR in Melbourne, Australia. Participants were administered the 9-item STAR-MH by non-mental health workers and subsequently interviewed (MINI 6.0) to determine psychiatric morbidity. Data was analysed by Rasch, CART and ROC analyses. Sensitivity/ specificity analyses determined the most accurate cut-off score to detect PTSD &/or Major Depressive Disorder (MDD).

Findings are based on 192 ASR from 36 countries. The median age was 33 (IQR=28–43) and the majority was male (70%), had arrived by boat (54%), and required an English language interpreter (65%). Median screening time was 6 minutes (IQR=5–7) with a screen-to-interview time of 5.5 days (IQR 0.0–9.0). 32% met criteria for at least one clinical diagnosis – 30% for MDD, 20% for PTSD – despite only 27% of these individuals having received mental health treatment in Australia. A cut-off score of ≥ 2 produced 0.93 (SN) and 0.74 (SP) for PTSD &/or MDD with a ROC of 0.91 p<.0001.

The STAR-MH is a simple, efficient screening tool to facilitate mental health referrals for adult ASR at their agency of first presentation.